Body Image and Psychosocial Adjustment in Adolescent Cancer Survivors

Examined body image and social adjustment in 21 adolescentswho had completed cancer treatment and a healthy comparisongroup. Subjects completed questionnaires assessing body imageand social adjustment and were videotaped during an interview.Raters blind to health status independently rated subjects’attractiveness. Cancer survivors reported less than half asmany social activities as the healthy controls. No group differenceswere found on social anxiety, loneliness, or composite bodyimage scores. However, within the cancer group adolescents whohad been off treatment longer reported lower self–worth,more social anxiety, and more negative body image perceptions,but were not rated as less attractive by observers. Findingssugest body image concerns and social anxiety may not developuntil several years after treatment termination.     

Sibling Adaptation To Childhood Cancer Collaborative Study: Siblings' Perceptions Of The Cancer Experience

Investigated responses of siblings (N = 254) of children withcancer to structured interviews designed to elicit thoughtsand feelings about effects of cancer on self and family. Siblingsindicated distress about family separations and disruptions,lack of attention, focus offamily on the ill child, negativefeelings in themselves and family members, cancer treatmentsand their effects, and fear of death. Siblings also reportedbecoming more compassionate, families becoming closer, and havingexperiences they otherwise would not have had. Age and genderdifferences in responses indicated distinctive perceptions ofand vulnerability to the cancer experience. Older siblings werefar more likely to report positive effects than younger siblingssuggesting that level of maturity can moderate the stress ofan ill child within the family.     

Psychological adjustment to pediatric physical disorders: a meta-analytic review.

Reviewed 87 studies of children's adjustment to physical disorders in a meta-analysis. Results indicate (a) children with such disorders show increased risk for overall adjustment problems, internalizing and externalizing symptoms; (b) risk was greatest in studies making comparisons to norms rather than to study controls; (c) risk varied by informant (teacher, mental health professional, parent), and by degree of matching with controls; (d) the self-concept of children with physical disorders across all studies appears significant for studies with careful matching or comparisons with norms; (e) there are interdisease differences, but the number of studies within individual disorders, with a few exceptions, are quite small. The need for improved methodology is discussed.     

Siblings of children with a chronic illness: a meta-analysis

OBJECTIVE: To review the literature pertaining to the siblings of children with a chronic illness. METHODS: Fifty-one published studies and 103 effect sizes were identified and examined through meta-analysis. RESULTS: We found (1) a modest, negative effect size statistic existed for siblings of children with a chronic illness relative to comparison participants or normative data; (2) heterogeneity existed for those effect sizes; (3) parent reports were more negative than child self-reports; (4) psychological functioning (i.e., depression, anxiety), peer activities, and cognitive development scores were lower for siblings of children with a chronic illness compared to controls; and (5) a cluster of chronic illnesses with daily treatment regimes was associated with negative effect statistics compared to chronic illnesses that did not affect daily functioning. CONCLUSIONS: More methodologically sound studies investigating the psychological functioning of siblings of children with a chronic illness are needed. Clinicians need to know that siblings of children with a chronic illness are at risk for negative psychological effects. Intervention programs for the siblings and families of children with a chronic illness should be developed.     

Brief Report: An Intervention Program for Parents of Pediatric Cancer Patients: A Randomized Controlled Trial

Objective: To evaluate a psychoeducational intervention programfor parents of pediatric cancer patients, using cognitive andbehavioral techniques. Methods: Parents were randomly assigned to an intervention (n= 39) and a control condition (n = 42). Baseline assessmenttook place at diagnosis. Short-term effects were measured immediatelyafter the intervention, long-term effects six months later.Control parents received standard care. Intervention parentsreceived, in addition, a manual-guided program during the firstsix months following the diagnosis. Results: With time all parents became significantly less psychologicallydistressed. However, no between-group differences were notedin psychological functioning, satisfaction with support, andintensity of emotions immediately postintervention and six monthslater. Conclusions: Although the clinical evaluation of the interventionwas positive, it appeared that a structured intervention programas described in this study was not any more effective than standardcare.     

Brief Report: Parenting Stress and Quality of Life During Treatment for Childhood Leukemia Predicts Child and Parent Adjustment After Treatment Ends

Evaluated relationships between parenting stress and parent-ratedchild quality of life during treatment for childhood leukemiaand later parental posttraumatic stress symptoms and parentand child anxiety after completion of cancer treatment in 29families of patients with leukemia. Correlations among in-treatmentand off-treatment variables showed strong patterns of associationbetween parenting stress during treatment and later parentaladjustment, for both mothers and fathers. Parent-rated childquality of life was also significantly associated with lateradjustment for mothers and children. Despite the small sample,data point to the importance and consistency of parental reactionsfrom diagnosis through the end of treatment and have clinicalimplications for psychosocial services during and after treatment.     

Psychological adjustment of children and adolescents with chronic arthritis: a meta-analytic review

OBJECTIVE: To review studies of psychological adjustment among children and adolescents with chronic arthritis to determine whether they are at more risk for development of adjustment problems than controls. METHODS: We used meta-analytic techniques to review 21 studies reporting overall adjustment problems, internalizing symptoms, externalizing symptoms, or self-concept among youths with arthritis. RESULTS: Youths with arthritis displayed increased risk for overall adjustment problems and internalizing symptoms, but not for externalizing symptoms or poor self-concept. Risk was greater in studies making comparisons to study controls rather than to norms and in studies including mixed disease samples (arthritis plus other rheumatic diseases) rather than samples of youths with arthritis only. CONCLUSIONS: Results suggest the importance of assessing for internalizing problems among youths with chronic arthritis. Future research may benefit from inclusion of child self-report of adjustment problems, diagnostic specificity in reporting results, and use of adjustment measures without somatic items.     

Adjustment to chronic arthritis of childhood: the roles of illness-related stress and attitude toward illness

OBJECTIVE: To examine the relationship of psychosocial stress and attitude toward illness to psychological adjustment among youth with chronic arthritis. METHODS: Seventy-five youths with chronic arthritis aged 8-18 years were administered a semi-structured interview assessing illness-related and nonillness-related stressors in important life domains. Children also completed measures of attitude toward illness, depressive symptoms, and anxiety. Parents completed a measure of child psychosocial adjustment. RESULTS: Higher levels of illness-related and nonillness-related stress were associated with higher levels of anxiety and depressive symptoms and parent-reported adjustment problems, while a more positive attitude toward illness was associated with lower levels of anxiety and depressive symptoms. Attitude toward illness moderated the relationship between stress and depressive symptoms. CONCLUSIONS: Results suggest the importance of assessing life stress and attitude toward illness among youth with arthritis and developing interventions to help children cope with arthritis-related stressors and promote a more positive attitude toward illness.     

Brief report: adjustment to juvenile rheumatoid arthritis: a family systems perspective

OBJECTIVE: To examine the relations of the family environment to adjustment to juvenile rheumatoid arthritis (JRA), and to examine how those relations are influenced by child sex and age. METHOD: Ninety-four children with JRA completed a questionnaire on family environment and adjustment. RESULTS: Family cohesion was related to good adjustment, whereas family conflict was related to poor adjustment. Some relations of family cohesion to adjustment were stronger for younger than for older children. The relations of child autonomy to adjustment depended on child sex and age. CONCLUSION: The relations of the family environment to adjustment to JRA are dependent on child sex and age.     

Childhood Sexual Abuse,Body Image,and Disordered Eating: A Structural Modeling Analysis

ABSTRACT

Based on previous literature, we proposed and tested a model of the relationships between child sexual abuse (CSA), body image, dieting, and bulimic behavior. The model specified that body image functioned as a mediator between CSA and eating disturbance. Multiple measures of each of the constructs of interest were collected from a sample of 222 college age women, and the data were analyzed using structural equation modeling. Both the measurement model and the proposed structural model demonstrated an adequate fit. As with previous research, results support a model in which body image strongly affects dieting behavior, which in turn directly affects bulimic behavior. The results did not appear to support the proposed mediational model involving the hypothesized indirect effect of CSA on eating pathology. There was, however, a small direct relationship between CSA and bulimic behavior and a moderate relationship between CSA and posttraumatic symptomatology.     

Psychological functioning of children with insulin-dependent diabetes mellitus: a longitudinal study

Assessed school-age youth repeatedly over the first 6 years of their insulin-dependent diabetes mellitus (IDDM) to determine self-perceived psychological adjustment. After the first year of IDDM, Ss exhibited a mild increase in depressive symptoms. Anxiety decreased for boys but increased for girls over the duration of IDDM. In contrast, self-esteem remained stable regardless of rehospitalizations or degree of metabolic control. Ss' adjustment shortly after IDDM onset, as reflected by levels of depression, anxiety, and self-esteem, were predictors of later adjustment. In general, Ss found the implications of IDDM more upsetting and the regimen more difficult with time, and girls were more upset by their illness than boys. The degree to which children were upset by the implications and management of IDDM varied as a function of their anxiety and depression.     

The Assessment of Posttraumatic Stress Disorder in Pediatric Cancer Patients and Survivors

Investigated the incidence and severity of Posttraumatic StressDisorder (PTSD) in childhood cancer using informant methodology.The parents of pediatric cancer patients (n = 30) and off-treatmentsurvivors (n = 42) completed a modified version of the PosttraumaticStress Disorder Symptom Scale (PSS) on their children (M age= 8.8: SD = 4.0), in addition to the Child Behavior Checklist(CBCL) and the Personality Inventory for Children (PIC). Medicaltreatment and demographic data were also collected for eachchild. The only variables that significantly identified thepresence of symptoms of PTSD were being on treatment at thetime of the evaluation or in the preparatory phase prior tobone marrow transplantation and not having received cranialirradiation. Results indicate that a full constellation of PTSDsymptoms can occur in children over the course of cancer treatment.Within the off-treatment pediatric cancer survivors, however,the incidence of PTSD was no greater than epidemiological estimatesfrom the general population. The concurrent validity of thePSS received support, and the results, while preliminary, suggestthat extended periods of medical trauma during which emotionalsupport is present may not excessively predispose children toPTSD.     

A Contextual Family/Systems Approach to Pediatric Psychology: Introduction to the Special Issue

Introduced the special issue on "Family System in PediatricPsychology" by organizing the papers around a series of themesrelevant to understanding families in pediatric psychology.Themes reflect the relationships between parent and child adjustment,family subsystems, legacies and traditions, social support systems,family interventions, the constancy of change in families, thechallenges of conducting longitudinal research, the inclusionof fathers, and the importance of a competency framework inpediatric family psychology. The paper concludes with recommendationsfor pediatric family psychology, including suggestions for increasingdiversity, expanding methodological approaches, and enhancingfamily competence.     

Psychological and Social Concomitants of Sickle Cell Anemia in Adolescents

Based on the hypothesis that adolescents with sickle cell anemiaexperience difficulty in mastering the normal developmentaltasks of adolescence because of the characteristics of theirdisease, this study examined body satisfaction, depression,and social withdrawal in 24 adolescents with sickle cell anemia.They were compared to 24 healthy adolescents matched on sex,race, age, and socioeconomic status. As predicted, the sicklecell anemic adolescents reported less satisfaction with theirbodies and more symptoms of depression than their healthy peers.In addition, they were found to spend less time in social andnonsocial activities. These results support the hypothesis thatadolescents with sickle cell anemia are at risk for psychosocialadjustment problems and suggest at least three areas of adjustmentthat may be affected.     

Brief report: Parental perceptions of child vulnerability in children with chronic illness

OBJECTIVE: To determine the extent to which parental perceptions of child vulnerability predict school and social adjustment in children with chronic illness. METHODS: Sixty-nine child-parent dyads were recruited from pediatric rheumatology and pulmonary clinics. Parents completed a self-report measure of parental perceptions of child vulnerability. Children completed measures of social adjustment. Parents also provided written permission to obtain school attendance records. Physicians provided a global assessment of children's disease severity. RESULTS: Increased parental perceptions of child vulnerability were related to increased social anxiety in children, even after controlling for child age and disease severity. Lower levels of parental education related to both increased perceptions of child vulnerability and increased school absences. CONCLUSIONS: Health providers should assess parental beliefs and parenting practices in assessing the adjustment of children with chronic illness. Moreover, interventions aimed at enhancing child adjustment to chronic illness might best target parents as well as children.     

The Influence of Sociocultural Factors on Body Image: Searching for Constructs

Body image is a multidimensional construct that has received increasing scientific study over the past few decades. Considerable research has examined the determinants of body image development and functioning and their implications for other aspects of psychosocial well-being, especially eating pathology among girls and young women. Cafri, Yamamiya, Brannick, and Thompson (this issue) reported the results of a meta-analysis of how selected, self-reported sociocultural influence variables correlate with the basic dimension of body image evaluation. Their work raises and reinforces important questions about the definition and measurement of sociocultural influence constructs.     

The Influence of Sociocultural Factors on Body Image: A Meta-Analysis

Various factors have been implicated in the development of body image dissatisfaction. Especially important are three constructs: awareness of a thin ideal, internalization of a thin ideal, and perceived pressures to be thin. Using meta-analysis, we calculated the strength of the relationships between each of these constructs and body image, and we evaluated the differences in magnitude across the average effect sizes. We also tested the moderating effects of age and ethnicity, and we compared the average effect sizes with those from meta-analyses of prospective and experimental studies in order to determine whether the effect sizes differed by study design. The results indicated the following: all three sociocultural factors had statistically significant relationships with body image; internalization and perceived pressures have a significantly stronger relationship to body image than does awareness; the effect sizes from cross-sectional studies were significantly larger than those of both longitudinal and experimental studies; and neither age nor ethnicity was a statistically significant moderator of the relationship between awareness and body image or that between internalization and body image. In this article, we discuss the limitations and implications of the findings on future research, theory, and clinical application.     

Brief report: the risk of posttraumatic stress disorder in mothers of children diagnosed with pediatric cancer and type I diabetes

OBJECTIVE: To evaluate the risk of and predictors of enduring and late-onset posttraumatic stress disorder (PTSD) among mothers of children diagnosed with type I diabetes and cancer. METHOD: Mothers (N = 99) of children diagnosed with cancer or diabetes for at least 12 months completed a structured clinical interview for PTSD and self-report measures of PTSD, depression, anxiety, and stressful life events. RESULTS: There was no significant difference in the rate of PTSD between the two groups. Overall, fewer mothers (7%) met criteria for PTSD on the structured clinical interview than those on a self-report measure of PTSD (17%). Mothers who reported more depressive symptoms, anxiety, and stressful life events tended to report significantly more PTSD symptoms. CONCLUSIONS: The findings extend prior research regarding the prevalence rate and predictors of PTSD and PTSD symptoms in pediatric populations. It is recommended that clinicians exercise caution when interpreting prevalence rates for PTSD that are derived from self-report measures.     

Brief report: illness uncertainty and dispositional self-focus in adolescents and young adults with childhood-onset asthma

OBJECTIVE: To investigate differences in self-focused attention between college students with childhood-onset asthma and a group of healthy controls and to determine whether self-focused attention mediates the relationship between illness uncertainty and psychological distress among individuals with asthma. METHODS: Forty-two adolescent and young adult participants with childhood-onset asthma and 40 age- and gender-matched healthy participants completed measures of self-focused attention, perceived illness uncertainty, psychological distress, and health status. RESULTS: Adolescents and young adults with childhood-onset asthma evidenced an increased tendency to engage in private self-focus compared to age- and gender-matched peers without a chronic illness history. Self-focused attention also mediated the relationship between perceived illness uncertainty and psychological distress among those with asthma. CONCLUSIONS: The need for self-monitoring in asthma management may result in an increased propensity to self-focus, which may result in heightened levels of psychological distress.